what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?


“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.


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Non-Thermal-Low-Level-Laser-as-an-aid-to-immunity-building-for-the-seasonal-nasties-seen-in-healthcare-and-clinical-practice.jpg

March 2, 2021

From autumn to spring we normally see colds, flu, aches and pains and a collection of seasonal nasties in clinical practice; no matter what discipline you practice in. if you have a non-thermal low-level laser, now is the time to put it so good use for you, your family, staff and clients. Have a read of this open literature review and see what conclusions you can draw. Given that this is 2020, this review leads with what’s topical, the evidence however is far reaching

This paper looks at the available research on using Non-thermal Low-Level laser as a therapy (NTLLLT), to improve and maintain a good immune response and is based on evidence, mindful of the current world situation in relation to Covid-19 and suggests that NTLLLT may be a viable intervention at this time for viral related seasonal nasties. This paper is not claiming the NTLLLT is a cure for Covid-19 or any disease, it’s merely based on what the evidence suggests.

Two strains of the new coronavirus that are spreading around the world, according to an analysis of 103 cases. But the World Health Organization insists that “there is no evidence that the virus has been changing”, viruses are intelligent and constant change and evolve.

Viruses are always mutating, especially RNA viruses like coronavirus SARS-CoV-2, and others. When a person is infected with the coronavirus, it replicates in their respiratory tract. Every time it does, around half a dozen genetic mutations occur, says Ian Jones at the University of Reading, UK.

When Xiaolu Tang et al at Peking University in Beijing studied the viral genome taken from 103 cases, they found common mutations at two locations on the genome. They identified two types of the virus based on differences in the genome at these two regions: 72 were considered to be the “L-type”(newer type), and 29 were classed “S-type” (older type).

A later analysis by Xiaolu Tang suggests that the L-type was derived from the older S-type. The first strain is likely to have emerged around the time the virus jumped from animals to humans, (anecdotally, there is a belief among some clinicians and members of the public, that this is not possible). The second type emerged soon after that species jump, according to Xiaolu et al. Both, we know, are involved in the current global outbreak. The fact that the L-type is more prevalent suggests that it is “more aggressive” than the S-type, the team say1.

Oxford Brookes University’s Ravinder Kanda, in the UK. Suggests that,  “The L-type might be more aggressive in transmitting itself, but we have no idea yet how these underlying genetic changes will relate to disease severity,”  Erik Volz at Imperial College London, in the same article says “I think it’s a fact that there are two strains” say “It’s normal for viruses to undergo evolution when they are transmitted to a new host.  The differences between the two identified strains are tiny.”

Coronaviruses are naturally hosted and evolutionarily shaped by bats and have been with us for a very long time. Indeed, it has been postulated that most of the coronaviruses in humans are derived from the bat reservoir. It is vital to know how many strains of the virus exist.

Coronaviruses were discovered in the mid 1960s by Tyrrell and Bynoe. The earliest discovered were an infectious bronchial virus in chickens and two in human pediatric patients who had what it was thought to be a common cold.  This was later named human coronavirus 229E and human coronavirus OC43. Other coronavirus type have been identified, these being, SARS-CoV in 2003, HCoV NL63 in 2004, HKU1 in 2005, MERS-CoV in 2012, and SARS-CoV-2 (formerly known as 2019-nCoV) in 2019. Most of these have involved serious respiratory tract infections.

Coronaviruses are large pleomorphic spherical particles with bulbous surface projections that look like a crown (corona). The diameter of the virus particles is around 120 nm. The envelope of the virus in electron micrographs appears as a distinct pair of electron dense shells.

The viral envelope consists of a lipid bilayer where the membrane, envelope and spike structural proteins are anchored. A subset of coronaviruses, specifically the members of Beta Coronavirus subgroup A, also have a shorter spike-like surface protein called hemagglutinin esterase (HE). Inside the envelope, there is the nucleocapsid, which is formed from multiple copies of the nucleocapsid protein, which are bound to the positive-sense single-stranded RNA genome in a continuous beads-on-a-string type structure or conformation. The lipid bilayer envelope, membrane proteins, and nucleocapsid protect the virus when it is outside the host cell.

Around the world, multiple groups are working on a vaccine for the virus. Any vaccine will need to target features that are found in both strains of the virus in order to be effective. Most promisingly, two drugs given together to treat HIV – called lopinavir and ritonavir – are already approved for human use, and in small trials they seemed to reduce disease severity and fatalities in people infected by the SARS or MERS coronaviruses (by reduction in the viral load). Doctors in Wuhan, the centre of the outbreak, have already started a randomised controlled trial of lopinavir and ritonavir. Covid-19 contains a strange HIV-like mutation that may make it more contagious and give it properties not found in other coronaviruses.

Based on what we know of HIV treatments and the links that have been drawn to it and the COVID-19 virus, it could be argued that the use of Non-thermal Low-Level Laser would have the same effect on coronavirus (by load reduction), as on HIV. Reactive species are frequently formed after viral infections. Antioxidant defences, including enzymatic and nonenzymatic components, protect against reactive species, but sometimes these defences are not completely adequate.

Oxygen radicals and nitric oxide (NO) are generated in excess in a diverse array of microbial infections. Emerging concepts in free radical biology are now shedding light on the pathogenesis of various diseases15, 16. Free‐radical induced pathogenicity in virus infections is of great importance, because evidence suggests that NO and oxygen radicals such as superoxide are key molecules in the pathogenesis of various infectious diseases. Although oxygen radicals and NO have an antimicrobial effect on bacteria and protozoa, they have opposing effects in virus infections such as influenza virus pneumonia and several other neurotropic virus infections.

An imbalance in the production of reactive species and the body’s inability to detoxify these reactive species is referred to as oxidative stress.

There is strong evidence which suggests that HIV-1 infected patients are under chronic oxidative stress, as are most viral infected patients. Thus, ROS has been suggested to be responsible for many aspects of HIV-1 pathogenesis such as increase viral replication, reduced immune cell proliferation, loss of immune function, and sensitivity to drug toxicity and chronic weight loss. Furthermore, excessive production of ROS can result in oxidation of proteins, peroxidation of lipids (seen in COVID-19), and eventually cell death. Non-thermal Low-Level Laser Therapy (NTLLLT), can improve the activity of antioxidant enzymes through a photochemical process that accelerates the elimination of ROS. This can be achieved at a molecular level by altering the conformation of antioxidant enzymes. A study conducted by Yang et al showed that LLLT (532 nm) can enhance the activity of anti-oxidant enzymes and also induce production of more ROS, with the amount produced dependent on the dose of the laser irradiation. Lugongolo et al in their paper on the treatment of HIV-1 suggest the use of 660 nm and also refer to a blue laser.

Non-thermal low-level lasers offer a collection of wavelengths, 400nm (blue violet), 530 nm (green), and 630 nm (red) and above. Lugongolo et al refer to similar frequencies.

Lugongolo et al, demonstrated the effects of laser irradiation in HIV-1 infected and uninfected TZM-bl cells. In addition, they showed that uninfected TZM-bl cells were stimulated by laser irradiation, while the effects of both HIV-1 infection and irradiation had detrimental effects on the cells. The TZM-bl cell line used in this study is a HeLa cell clone containing the CXCR4, CD4 and CCR5, which are host cell molecules the virus uses to gain entry into cells and making TZM-bl cell line permissive to HIV-1 infection. The TZM-bl cell line also contains a Tat-responsive firefly luciferase gene under the control of HIV-LTR, which gets expressed during HIV infection.

Herpes zoster, also known as shingles, produces a painful vesicular rash that results from the reactivation of the varicella zoster virus (VZV) treated with 632 nm responds in a similar way to HIV when irradiated using NTLLLT at 660 -880 nm. Both of these viruses respond to NTLLLT. 405 nm laser has also been investigated in the treatment of viral conditions.

An early study in 1991 by Skobelkin et al; performed preoperative NTLLLT on selected cancer patients undergoing palliative surgery. The levels of T-lymphocytes, T-helpers and Tsuppressors were assayed for the 7 days following the surgery, as were immunoglobulin levels, specifically IgA, IgM and IgG. The levels of blood-borne leukocytes, lymphocytes and monocytes all rose after laser therapy. Significantly increased levels of activated Tlymphocytes and helper T-cells were seen, with a significantly lower number of T-suppressors especially by the fifth post NLLLT day. Increased levels of IgA and IgG were seen by the second day, with a sharp reduction to almost normal levels by the fifth day. IgM levels rose slowly over the first four days, then rose sharply on the fifth day and maintained a high level during the period of the study. Skobelkin et al, proposed that these were all indications of a strong photoactivated immunological response, and boosting the competency of the immunocompetent systems of these long-term cancer patients. The high levels of IgG, especially cytotoxic for tumoural cells, has also been associated with a corresponding rise in killer T-cells. the antigen which would normally trigger these reactions was shown to be absent in all patients, thus the reaction was entirely photoactivated. Skobelkin et al, did not report any activation of tumoural remnants following LLLT, which has been of major concern to many researchers.

It could be concluded that utilising NTLLLT in in a proactive way, as a support to immunity, could be generally beneficial to the population, and in so doing give an immune boost to protect from the seasonal nasties. Consider it as a laser flu shot or an immune infusions. Our bodies have everything we need for a happy healthy life, all we sometime lack is the energy to be well, NTLLLT bring the energy to our cells that they need and can use to boot our immunity.

 

Reference:

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doi:10.1016/S0065-3527(08)60286-9. ISBN 9780120398485. PMID 9233431.

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Ziebuhr J (2011). “Family Coronaviridae”. In King AM, Lefkowitz E, Adams MJ, Carstens EB, International Committee on Taxonomy of Viruses, International Union of Microbiological Societies. Virology Division (eds.). Ninth Report of the International Committee on Taxonomy of Viruses. Oxford: Elsevier. pp. 806–28. ISBN 978-0-12-384684-6.

  1. Chang CK, Hou MH, Chang CF, Hsiao CD, Huang TH (March 2014). “The SARS coronavirus nucleocapsid protein–forms and functions”. Antiviral Research. 103: 39–50. doi:10.1016/j.antiviral.2013.12.009. PMID 24418573.
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  3. Tyrrell DA, Bynoe ML. Cultivation of viruses from a high proportion of patients with colds. Lancet. 1966;1:76–77.
  4. Skobelkin, O.K., Michailov, V.A., & Zakharov, S.D. (1991). Preoperative activation of the immune system by low reactive level laser therapy (lllt) in oncologic patients : a preliminary report.

Dr. Sanjay Parashar

Non-Thermal-635nm-Low-Level-Laser-Therapy-in-Pre-Diabetes-and-Obesity-Management.jpg

March 2, 2021

Background

Pre-Diabetes and pre-obesity often go hand in hand. Diabetes mellitus (DM) is a chronic condition that can alter our carbohydrate, protein, and fat metabolism. It is caused by the absence of insulin secretion due to either the progressive or marked inability of the β-Langerhans islet cells of the pancreas to produce insulin, or due to defects in insulin uptake in the peripheral tissue. DM is broadly classified under two categories, which include type 1 and type 2 diabetes.

Body mass index has a strong relationship to diabetes and insulin resistance. In obese individuals, the amount of non-esterified fatty acids (NEFA), glycerol, hormones, cytokines, proinflammatory markers, and other substances that are involved in the development of insulin resistance, is increased.

The pathogenesis in the development of diabetes is due to the β-islet cells of the pancreas becoming impaired, causing a lack of control of blood glucose. The development of diabetes becomes more inevitable if the failure of β-islet cells of the pancreas is accompanied by insulin resistance. Weight gain and body mass are central to the formation and rising incidence of type 1 and type 2 diabetes.

In conclusion, new approaches in managing and preventing diabetes in obese individuals must be studied and investigated based on the facts. True Non-Thermal Low-Level Laser (TNTLLL)may form part of the solution.

The association between type 1 diabetes and weight gain was first investigated by Baum et al in 1975. The Baum et al study suggested that there was an association related to overfeeding or to hormonal dysregulation.

Overweight and obesity are defined by an excess accumulation of adipose tissue which impairs both physical and psychosocial health and well-being. Obesity is considered a health disaster in both developed and developing countries.

The increased prevalence of obesity in the current climate has drawn attention to the worldwide significance of this problem. In the US, approximately two-thirds of the adult population is overweight or obese and similar trends are being noticed worldwide. Obesity is linked to many medical, psychological, and social conditions, the most devastating of which may be type 2 diabetes. At the start of this century, 171 million people were estimated to have type 2 diabetes, and this figure is expected to increase to 360 million by 2030. The figures from the World Health Organisation show that around 422 million people worldwide have diabetes, with the majority living in low-and middle-income countries, and 1.6 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. A comparison of the two sets of statistics shows just what a combined problem these two conditions represent. The Pharmacoeconomics, not to mention the associated costs on health services is staggering. In 2016 the estimated burden of diabetes on healthcare infrastructure was 825 Billion USD. There are no published figures for 2020, but it is estimated to be more than a trillion USD.

The Study

The study enrolled 140 men and women between the ages of 18 to 70 with a body mass index (BMI) of 27 to 45. This was a 24 month study including follow up. Participating subjects were randomised in a double-blind fashion to receive non-thermal low-level laser. The study was set up as below.

Non-esterified fatty acids (NEFA) are molecules released from triglycerides by the action of the enzyme lipase and are transported in the blood bound to albumin. They contribute only a small proportion of the body’s fat; however, provide a large part of the body’s energy. Measurement of NEFA is important in diabetes where insulin deficiency results in the metabolism of fat. Levels are also frequently increased in obese patients.

Subject sample

Active Subjects Placebo Subjects Total Subjects
70 70 140

Subject demographics

Gender

Group Male Female Total
Active 35 (50%) 35 (50%) 70 (50%)
Placebo 37 (53%) 33 (47%) 70 (50%)

Age

Group Active Placebo Total
Mean 50.13 49.24 49.69
SD 9.78 9.78 9.76
Range 35 – 65 33 – 70 33 – 70

A t-test for independent samples reported a difference of 0.89 years between randomized subjects to the active and placebo treatment groups to be not statistically significant (t=+0.54, p=0.59; p>0.05).

All subjects involved in this study were recommended and referred by their medical team and had to be pre-diabetic and pre-obese or obese and not taking medication for these conditions.

Treatment device.

The low-level laser energy device is a non-invasive dermatological aesthetic treatment cleared by the FDA for use as a non-invasive aesthetic dermatological treatment for reducing the circumference of hips, waist, and thighs and is manufactured by Erchonia Corporation, USA. The LLLT device consists of four independent diodes that are positioned 120 degrees apart and tilted at a 30-degree angle. A fifth diode is positioned at the centreline.

The 17mW of red 635nm of laser light emitted from each diode is collected and processed through a proprietary lens that redirects the beam with a line refractor. The refracted light from each diode is bent into a random spiralling circle pattern that is independent of the other diodes. These overlapping patterns ensure total coverage of the target treatment area. The total amount of energy delivered to the skin during each treatment as stated in the FDA clearance was 3.94J/cm2. Evidence however suggests that this is not relevant as the laser delivers photonic energy via electromagnetic energy transfer.

Procedure.

Each subject was randomised to receive 20 active or sham treatments 2 per week, equally spaced apart with the low-level energy laser device over a 10 week period. Both the active and sham devices have the same physical appearance and emit light when activated that is indistinguishable to both the subject and the administration investigator. All subjects had moderated exercise sessions after each treatment, and another on a day of their choice. Nutritional plans were also moderated for compliance.

Study assessments.

The circumference of each participant was measured using a flexible tape measure pre- and post- each application at 3 points; the base of the circumference at sternum, the circumference at the umbilicus, and again at the trochanter.  For accuracy at remeasuring post treatment, a skin marker was used under the tape at several points so the measurements were duplicated. These points were recorded at baseline to ensure that subsequent measurements were obtained at the same location. All measurements were performed by a member of the investigative team not involved in performing the actual treatments. All subjects were photographed from front, sides and back with hands on head.

The primary outcome measure was the number of subjects accumulated BMI and the total decrease achieved. Individually the three combined measurement points after each session were recorded. Blood glucose was also measured each week along with weight and other

variables such as sleep quality and energy levels. Secondary outcomes assessed at the completion of the study included changes in BMI, associated diabetes risk, obesity levels and several subjective ratings, which measured subject attitudes about overall satisfaction with their results and improvements in the appearance.

All study assessments were performed at baseline, at the completion of treatment, and two weeks post-treatment. Following the baseline physical examination, a blinded investigator noted any changes in existing skin condition including scars, cellulite, stretch marks, discoloration, stria, dimpling, skin quality and elasticity following treatment. Details about food and drink consumption, physical activity, and adverse events for each subject were recorded daily. Further follow ups were recorded every 12 weeks primarily for the first 18 months from inception, then extended over the 5 year period. The study is now concluded.

Ethics.

The protocol used in this study adhered to the Good Clinical Practice guidelines and was approved by the local ethics committee in April 2015. The study was overseen by colleagues in the diabetes assessment unit at the local university hospital.   Informed written consent was obtained from each subject prior to participation in any study-related activities.

Laser Diode Placement

The diodes are placed over the lateral flanks and around the umbilical area. The treatment was performed for 20 minutes and is repeated for a further 20 minutes, with the participant repositioned. A more comfortable method for a heavier subject is for them to lay on their side and the diodes positioned accordingly to cover half of the midsection, the subject then repositions to the other side.

Rational

To find an alternative to the current interventions for diabetes, obesity and associated conditions, to reduce the overall economic burden, and to improve quality outcomes and quality of life for sufferers.

Baseline variables

BMI

Group Active Placebo Total
Mean 5.09 5.62 5.35
SD 1.65 1.80 1.74
Range 3.1 – 8.8 3.1 – 9.1 3.1 – 9.1

A t-test of independent samples found the 0.53 difference in baseline Total Cholesterol between subjects randomized to the active and placebo treatment groups to be not statistically significant (t=-1.82, p=0.071; p>0.05).

Throughout the study all participants had their blood pressure, cholesterol and blood sugars monitored. Changes in behaviour were also considered as was sleep patterns, changes in energy levels and general skin appearance. A glycated haemoglobin test (HbA1c) was taken every 12 weeks.

Total Cholesterol

Group Active Placebo Total
Mean 5.09 5.62 5.35
SD 1.65 1.80 1.74
Range 3.1 – 8.8 3.1 – 9.1 3.1 – 9.1

A t-test for independent samples found the 0.53 difference in baseline Total Cholesterol between subjects randomized to the active and placebo treatment groups to be not statistically significant (t=-1.82, p=0.071; p>0.05).

HbA1c

Group Active Placebo Total
Mean 6.46 6.46 6.86
SD 0.18 0.16 4.70
Range 5.52 – 6.66 5.2 – 6.61 5.2 – 6.66

There is no difference (0 points) in baseline HbA1c between subjects randomized to the active and placebo treatment groups.

Comparisons across evaluations

The following evaluations of study variables were made:

  1. Baseline (pre-treatment)
  2. End of Treatment
  3. Follow-up

The following analyses evaluate the change in evaluations for each study measure across the three evaluations, as applicable.

BMI

BMI Baseline Treatment End Follow-Up
Active               Mean 33.41 30.54 25.86
                             SD 2.67 2.35 1.39
Placebo            Mean 33.57 31.86 36.40
                             SD 3.16 3.12 1.86

As this is a simple inhouse study, the information shared would benefit from more testing within a full RTC. The lead researcher and his team maintained strict protocols throughout this study (see appendix 1).

A one-way ANOVAs for 3 correlated samples was conducted to evaluate change in BMI across the study duration within each of the active and placebo treatment groups, with results as follows:

Active Group

There is a statistically significant difference in BMI ratings across the study evaluation duration for active group subjects (F=563.65, p<0.001). Subsequent Tukey Analysis revealed the statistically significant differences to have occurred between the following evaluations, at p<0.01:

  • Baseline to Treatment End
  • Baseline to Follow-Up
  • Treatment End to Follow-Up

Placebo Group

There is a statistically significant difference in BMI ratings across study evaluation duration for placebo group subjects (F=93.71, p<0.001). Subsequent Tukey Analysis revealed the statistically significant differences to have occurred between the following evaluations, at p<0.01:

  • Baseline to Treatment End
  • Baseline to Follow-Up
  • Treatment End to Follow-Up

In summary, both active and placebo subject groups evidenced a statistically significant decrease in BMI from pre-treatment to treatment end evaluation. However, while both groups likewise evidenced statistically significant changes in BMI from treatment end to follow-up evaluation, this change was in the direction of a statistically significant mean decrease for active group subjects and a statistically significant mean increase for placebo group subjects. By follow-up evaluation, active group subjects evidenced a mean decrease in BMI of 7.55. In contrast, placebo group subjects evidenced a mean increase in BMI of 2.83 across the same evaluation period.

Furthermore, while a t-test for independent samples found a 0.16 difference in baseline (pre-treatment) BMI between active and placebo subject groups to be not statistically significant (p>0.05), the 10.54 difference in BMI between active and placebo groups at follow-up evaluation was seen as statistically significant (p<0.0001).

HbA1c

HbA1c Baseline Treatment End Follow-Up
Active               Mean 6.46 5.66 4.68
                             SD 0.18 0.20 0.40
Placebo            Mean 6.46 6.10 9.56
                             SD 0.16 0.26 1.67

A one-way ANOVA for 3 correlated samples was conducted to evaluate change in HbA1c across study duration within each of the active and placebo treatment groups, with results as follows:

Active Group: There is a statistically significant difference in HbA1c ratings across study evaluation duration for active group subjects (F=797.77, p<0.0001). Subsequent Tukey Analysis revealed the statistically significant differences to have occurred between the following evaluations, at p<0.01:

  • Baseline to Treatment End
  • Baseline to Follow-Up
  • Treatment End to Follow-Up

Placebo Group: There is a statistically significant difference in HbA1c ratings across study evaluation duration for placebo group subjects (F=274.79, p<0.0001). Subsequent Tukey Analysis revealed the statistically significant differences to have occurred between the following evaluations, at p<0.01:

  • Baseline to Follow-Up
  • Treatment End to Follow-Up

In summary, similarly to the BMI findings, both active and placebo subject groups evidenced a decrease in HbA1c from pre-treatment to treatment end evaluation, although the decrease was only statistically significant for the active treatment group at p<0.01. However, while both groups evidenced statistically significant changes in HbA1c from treatment end to follow-up evaluation, this change was a statistically significant decrease for active group subjects and a statistically significant increase for placebo group subjects. By follow-up evaluation, active group subjects evidenced a statistically significant mean decrease

in HbA1c of 1.78 relative to baseline. In contrast, placebo group subjects evidenced a statistically significant mean increase in HbA1c of 3.10 across the same evaluation period.

Furthermore, while there was no difference in baseline (pre-treatment) HbA1c between active and placebo subject groups (both 6.46), the 4.88 difference in mean HbA1c between active and placebo groups at follow-up evaluation was statistically significant in favor of a significantly lower HbA1c for active group subjects relative to placebo group subjects (p<0.0001).

Total Cholesterol

Total Cholesterol Baseline Follow-Up
Active               Mean 5.09 3.53
                             SD 1.65 0.50
Placebo            Mean 5.62 5.76
                             SD 1.80 1.49

T-tests for correlated samples were conducted to evaluate change in total cholesterol across the study duration for each of the active and placebo treatment groups, with results as follows:

Active Group

T=10.11, p<0.0001. There is a statistically significant 1.56-point decrease in total cholesterol ratings from pre-treatment to treatment follow-up evaluation for active group subjects.

Placebo Group

There is no change in total cholesterol ratings from pre-treatment to follow-up evaluation for placebo group subjects (t=-1.32, p=0.19; p>0.05), with the 0.14-point increase being not statistically significant.

Furthermore, while there was no statistically significant difference in baseline (pre-treatment) total cholesterol between active and placebo subject groups (p>0.05), the 2.23-point difference in mean total cholesterol between active and placebo groups at follow-up evaluation was statistically significant (t=-11.89, p<0.0001).

Blood pressure

Blood pressure was recorded at baseline (pre-treatment), treatment end, and follow-up.

At baseline, blood pressure readings for all subjects in both the active and placebo groups were within the Hypertension Group 1 or Group 2 category.

Across treatment end and follow-up evaluations, all 70 subjects in the active treatment group demonstrated a progressive improvement (lowering) in blood pressure readings, and 12 active group subjects had lowered their blood pressure reading to within the pre-hypertension range by follow-up evaluation.

In contrast, there were no notable improvements in blood pressure readings for any of the 70 placebo group subjects from pre-treatment to follow-up evaluation, and no placebo group subject recorded a blood pressure rating below the Hypertension Stage 1 category at follow-up evaluation.

Sleep quality: P, A, I, G, E.

The P, A, I, G, E sleep quality scale used in this study is provided below.

P = You take more than 30 minutes to fall asleep after you get into bed.

You regularly wake up more than once per night.

You lie awake for more than 20 minutes when you wake up in the middle of the

night.

Feel tired quickly upon wakening.

A = You take less than 30 minutes to fall asleep after you get into bed.

You wake no more than once per night.

Your sleep is restless and your bed is tossed when you awaken.

Feel tired midday.

I = You take less than 20 minutes to fall asleep after you get into bed.

You wake no more than once per night.

You return to sleep quickly but sleep light.

Feel tired in the afternoon.

G = You fall asleep quickly after you get into bed.

You wake occasionally in the night.

You return to sleep quickly if you do awaken.

You seldom feel tired in the day.

E = You fall asleep quickly after you get into bed.

You do not wake in the night.

You awaken naturally and feel refreshed.

You never feel tired in the day.

Therefore, progression from ‘P’ through ‘E’ represents improvement in sleep quality.

Below is a summary of the percentage of subjects in each of the active and placebo groups, respectively, who rated their sleep quality on this scale as ‘P’, ‘A’, ‘I’, ‘G, or ‘E’ at each of the three evaluations.

Active Group Baseline Treatment End Follow-up
P 30 (43%) 1 (1%)
A 29 (41%) 12 (17%)
I 37 (53%) 9 (13%)
G 11 (16%) 12 (17%) 13 (19%)
E 9 (13%) 47 (67%)

At basepoint evaluation, eighty-four per cent (84%) of active group subjects rated their sleep quality as ‘P’ or ‘A’ – the two poorest sleep quality categories. By Follow-Up evaluation, only one active group subject reported poor sleep quality, and each of the remaining active group subjects indicated improved sleep quality, with 86% of active group subjects reporting their sleep quality as ‘G’ or ‘E’ – the two best sleep quality categories.

Placebo Group Baseline Treatment End Follow-up
P 39 (56%) 20 (29%) 21 (31%)
A 24 (34%) 37 (53%) 19 (28%)
I 11 (16%) 13 (19%)
G 7 (10%) 2 (2%) 15 (22%)
E

Similarly to active group subjects, 90% of placebo group subjects rated their sleep quality as ‘P’ or ‘A’ – the two poorest sleep quality categories – at baseline evaluation. However, by Follow-Up evaluation, 59% of placebo group subjects continued to record a ‘P’ or ‘A’ rating compared with the single active group subject, and only 22% of placebo group subjects reported their sleep quality as ‘G’ or ‘E’ – the two best sleep quality categories at follow-up evaluation compared with 86% of active group subject – almost four times fewer.

At the end of the 10 week active phase, all the subjects in the active protocol had undergone 4 weeks of further monitoring in relation to their blood glucose levels, and 69 of them no longer presented as a diabetes risk. The control group however all remained on the diabetes index as being at risk at week 10 +4.  All subjects were encouraged to follow their established exercise routine and to foster their nutritional habits. Follow-ups were taken for 24 months.

In the control group 69 went on to develop diabetes and one died because of complications related to diabetes. Over time their weight increased. The female members of the group maintained reduced weight and cholesterol levels. All of the subjects continued with exercises and a reasonable diet.

Discussion

There is a growing body of research showing the benefits of NTLLL in the management of the human fat cell, pain management and neurological disorders but as yet there is no substantive research into the benefits of this technology in the management of obesity and diabetes. Weight contributed to rheumatoid arthritis, heart disease, osteoarthritis, is now a contributory factor in problems associated with the coronavirus. There are well recorded positive side effects associated with the use of NTLLL[i], and these effects need to be exploited. This is a simple inhouse study exploring the use of NTLLL at 635nm in pre-diabetes/pre-obese patients.  Can we do anything to reduce the potential development of diabetes?

Conclusion

Diabetes is potentially a life limiting condition and fraught with many comorbidities.  Patients may go on to develop issues with blood pressure, kidneys, neuropathies, and amputations. The list is practically endless. This study, though inhouse, has followed best practice in terms of RTC, and though it is not perfect, the evidence presented speaks for itself. NTLLL may have a place in the armament of treatments used to prevent and control what is one of the world’s biggest health issues. 65 out of 70 participants in the study who were pre-diabetic and pre-obese, and in a 10 week period, turned their lives around. Over a 5 year period they continued to improve and maintained the good habits they had formed on the study.  They were no longer a diabetes risk and were not obese, and they all had good cholesterol levels and no blood pressure issues. They are no longer a burden on the healthcare systems. Although further studies are required, NTLLL could have long lasting benefits for diabetes, obesity, and health generally.

 

Reference:

  1. Scheen AJ. Pathophysiology of type 2 diabetes. Acta Clin Belg. 2003;58(6):335–341.
  2. van Belle TL, Coppieters KT, von Herrath MG. Type 1 diabetes: etiology, immunology, and therapeutic strategies. Physiol Rev. 2011;91(1):79–118.
  3. Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity : targets and therapy, 7, 587–591. https://doi.org/10.2147/DMSO.S67400
  4. Baum JD, Ounsted M, Smith MA. Letter: Weight gain in infancy and subsequent development of diabetes mellitus in childhood. Lancet. 1975;2(7940):866.
  5. Naser KA, Gruber A, Thomson GA. The emerging pandemic of obesity and diabetes: are we doing enough to prevent a disaster? Int J Clin Pract. 2006;60(9):1093–1097.
  6. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72(3):694–701.
  7. Arora S. Insulin Resistance. Rijeka, Croatia: InTech Europe; 2012. [Accessed September 26, 2014]. Molecular basis of insulin resistance and its relation to metabolic syndrome.
  8. Tsai AG, Williamson DF, Glick HA. Direct medical cost of overweight and obesity in the USA: a quantitative systematic review. Obes Rev. 2011;12(1):50–61.
  9. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991;337(8738):382–386.
  10. https://www.who.int/health-topics/diabetes#tab=tab_1
  11. https://www.hsph.harvard.edu/news/press-releases/diabetes-cost-825-billion-a-year/
  12. Farivar, S., Malekshahabi, T., & Shiari, R. (2014). Biological effects of low level laser therapy. Journal of lasers in medical sciences, 5(2), 58–62.

Dr. Sanjay Parashar

Understanding-Non-Thermal-Low-Level-Lasers-Its-not-all-about-penetration.jpg

March 2, 2021

Put simply, Non-Thermal Low-Level Laser (NTLLL) delivers energy to the mitochondria of cells. This energy is delivered as photons or light particles, and this process is referred to as electromagnetic energy transfer. The aim of this article is to provide a brief synopsis to help the reader understand electromagnetic waves (EMW) and NTLLL.

Electromagnetic energy is a type of energy that is able to travel at the speed of light, it is characterised as having both electric and magnetic fields.

From humble beginnings more than 100 years ago, EMR has become an important component of modern medicine. There is an urgent need for education and better understanding with respect to its principles and applications.

The application of this energy is not new, Endre Mester at the Semmelweis Medical University in Hungary understood its effect.  In 1998, Wilden showed the importance of low-level laser in the delivery of energy.  Wilden went on to say, “Depending on its wavelength, electromagnetic radiation in the form of light can stimulate macromolecules and can initiate conformation changes in proteins or can transfer energy to electrons. Low level laser from the red and the near infrared region corresponds well with the characteristic energy and absorption levels of the relevant components of the respiratory chain”. What he was talking about is Non-Thermal Electromagnetic Transfer via Light. NTLLL is a collimated, monochromatic, unidirectional beam of light from the visual light spectrum. The visible spectrum is the portion of the electromagnetic spectrum that is visible to the human eye.

When you take visual light from the electromagnetic radiation spectrum, depth of penetration in terms of NTLLL becomes totally irrelevant. It is not about penetration, it’s about the wave. The concept of a wave is very familiar to all of us.  We have all seen waves travel across the beach, some are short and fast, while others are fast and slower, and some are just ripples. Electromagnetic radiation/Visual light, is very much like that.

Electromagnetic radiation is part of our everyday lives.  These waves are penetrating our bodies 24 hours a day, 7 days a week, and they never stop. Life could not function without them. Electromagnet waves have many characteristics, and their two most fundamental are wavelength and frequency. Figure 1.1 shows a sinusoidal electromagnetic wave in general. The direction axis of the wave is marked by z this is sometime called the  k-vector. EM waves have two oscillating parts, one electric the

other magnetic (x and  y in the diagram). The magnetic field is at right angles to the electric field and vice versa.

As can be seen from the above diagram, the wavelength is the distance (nanometres nm) between two adjacent peaks or troughs. This distance is measured along the axis z.  How many times per second the wave oscillates is the frequency. EM waves pass through the body without causing any damage.

When we relate the above information to NTLLL, and the fact that they operate from the visual light part of the electromagnetic spectrum; they use minimal power to generating a stable laser beam, and this beam consists of an electromagnetic wave that passes through the body.  Depth of penetration is irrelevant.

There are hundreds of so called lasers out there, and some are lasers, whilst some are not. A True laser is a device that generates an intense beam of coherent monochromatic light (or electromagnetic radiation) by stimulated emission of radiation (photons) from excited atoms or molecules.  Any device claiming to be a laser must exhibit these qualities.

Our bodies rely on photons to maintain good health. Energy from photons or light particles can be absorbed or released by electrons. When an electron absorbs a photon, the energy can free the electron to move around, or the electron can release the energy as another photo. Biophotons are light particles that are generated within the body and are constantly radiated from the body surface. These spontaneous emissions are thought to be associated with generation of free radicals due to energy metabolic processes.

 

References:

  1. Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012;40(2):516‐ doi:10.1007/s10439-011-0454-7
  2. https://imagine.gsfc.nasa.gov/science/toolbox/emspectrum1.html
  3. Paweł Sowa, Joanna Rutkowska-Talipska, Urszula Sulkowska, Krzysztof Rutkowski, Ryszard Rutkowski, Electromagnetic radiation in modern medicine: Physical and biophysical properties, Polish Annals of Medicine, Volume 19, Issue 2, 2012,
  4. Hamblin MR. Photobiomodulation or low-level laser therapy. J Biophotonics. 2016;9(11-12):1122‐ doi:10.1002/jbio.201670113
  5. Wilden L, Karthein R. Import of radiation phenomena of electrons and therapeutic low-level laser in regard to the mitochondrial energy transfer. J Clin Laser Med Surg. 1998;16(3):159‐ doi:10.1089/clm.1998.16.159
  6. Sliney DH. What is light? The visible spectrum and beyond. Eye (Lond). 2016;30(2):222‐ doi:10.1038/eye.2015.252
  7. https://www.google.com
  8. Van Wijk R, Van Wijk EP, Wiegant FA, Ives J. Free radicals and low-level photon emission in human pathogenesis: State of the art. Indian J Exp Biol. 2008;46:273–309. [PubMed]
  9. Rastogi A, Pospísil P. Spontaneous ultraweak photon emission imaging of oxidative metabolic processes in human skin: Effect of molecular oxygen and antioxidant defense system. J Biomed Opt. 2011;16:096005.
  10. Srinivasan TM. Biophotons as Subtle Energy Carriers. Int J Yoga. 2017;10(2):57‐58. doi:10.4103/ijoy.IJOY_18_17

Dr. Sanjay Parashar


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